LEARN MORE ABOUT GETTING STARTED WITH MEDICARE.

Using Your Medicare Benefits/Helpful Tips
Medicare Made Clear

GETTING STARTED WITH MEDICARE

Medicare is a national health insurance program for people ages 65+, or younger individuals with certain disabilities.

Like most other insurance programs, Original Medicare does not pay for all health care costs. You must pay for deductibles, premiums, coinsurance or copayments. Original Medicare - which includes Parts A and B - does not pay for long term care, extended stays in nursing homes or coverage when outside of the country. Coverage gaps like these are why some people choose to buy additional coverage. (For more information on any of these terms, please visit the Heath Insurance Terms Glossary link on this page.)

You have choices with how you receive Medicare. The first of which is whether to go with Original Medicare or with a Medicare Advantage plan. Once you determine how to receive your primary coverage, you should consider options for prescription drug coverage. Many Medicare Advantage plans include prescription drug coverage - you can also enroll in a Medicare Part D plan as an alternative. The options you choose affect the cost and level of your coverage. For more information on the parts of Medicare, as well as plans to supplement Medicare coverage, please see Types of Medicare and Supplemental Coverage

SIGNING UP

If you plan to use Medicare for health coverage after the age of 65, you should consider signing up for Medicare Parts A and B up to three months prior to turning 65. You can sign up for Part A and Part B through your local Social Security office. Or, if you want to enroll in Medicare Part D or a Medicare Advantage plan (also known as Part C) you can do so through the Medicare-approved private insurance company of your choice. You may only enroll during specific enrollment periods, unless you qualify for a Special Enrollment Period. Don't put off enrolling in Medicare! If you don't sign up for Part B or Part D when you are first eligible, you may have to pay a penalty when you enroll later.

TELL US YOUR PREFERENCES

Share Your Preferences with AARP. Get the information you want. Take AARP's short preference survey to select which topics interest you. Click Here

TYPES OF MEDICARE AND SUPPLEMENTAL COVERAGE

Original Medicare, or traditional Medicare, is a fee-for-service health plan, meaning that you are free to choose any doctor or hospital that accepts Medicare and you're responsible for any costs not covered by the plan.

Original Medicare consists of Part A (Hospital Insurance) and Part B (Medical Insurance). Part A helps pay for various types of care, including inpatient hospital care, limited nursing home care, and home health and hospice care. Part B helps pay for doctor visits, medical equipment, some preventive services, some outpatient home health and hospital care, rehabilitation therapy, laboratory tests, x-rays, mental health services, ambulance services and blood work.

Part A generally requires no premiums because its costs are covered by Medicare taxes paid during your working years (or that of your spouse). In some cases, premiums may apply. Coverage for Part B is optional. You are required to pay a monthly premium for Part B coverage, deducted from your Social Security payments, plus an annual deductible and a coinsurance payment - equal to 20 percent of approved costs charged by your doctor. Some people who wait to sign up for Part B until after their initial qualification period has expired must pay late enrollment penalty.

Original Medicare pays for many health care services and supplies, but does not cover all of your health care costs. To get drug coverage under Original Medicare (also known as Part D), you must also choose and join a Medicare-approved drug plan provided by a private insurance company.

Medicare Advantage Plans, also known as Medicare Part C, offer an alternative to Original Medicare. These plans replace your coverage under Parts A and B, and sometimes include additional coverage. They often (but not always) include a specific network of doctors and health care providers you can use to receive care, sometimes at lower costs. Examples of Medicare Advantage plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs) and Private-Fee-For-Service (PFFS) plans.

Medicare Prescription Drug Coverage, or Part D, can help reduce the costs of prescription drugs. Unlike Medicare Parts A and B, Part D plans are offered by private insurance companies. No matter where you live, you have access to several different plans and sponsors with varying benefits and costs. Medicare drug plans don't necessarily cover every prescription medicine, but by law, they provide choices within each drug category. They do not cover over-the-counter medicines. Like other insurance, Part D plans require premiums, co-payments, coinsurance and sometimes deductibles.

A Medicare Supplemental Insurance, or Medigap, policy is health insurance sold by private insurance companies to fill the "gaps" in Original Medicare Plan coverage. If you are in the Original Medicare Plan and have a Medicare supplement policy, then Medicare and your Medicare supplement policy will both pay their shares of covered health care costs. Insurance companies can only sell you specific Medicare supplement policies that are standard in all states. These policies must all have specific benefits so you can compare them easily. On June 1, 2010, changes to these standardized plans from the 2008 Medicare Improvements for Patients and Providers Act (MIPPA) went into effect. All the Medicare Supplement plans sold after this date include these new improvements.

Generally, when you buy a Medicare supplement policy, you must have Medicare Part A (hospital coverage) and Part B (medical coverage). You must pay the monthly Medicare Part B premium and pay a premium to the Medigap insurance company. For additional information on Medicare supplement policies, including why you may want to buy one and what Medicare supplement policies cover, consider reading Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare

LEARN MORE ABOUT MEDICARE WITH THE LINKS ON THIS PAGE.

Closer Look - Medicare Parts A & B
Closer Look - Medicare Part C
Closer Look - Medicare Part D
AARP MedicareRx - Look Up Prescription Drugs
Overview of Medicare Supplement Plans
Compare Medicare Supplement Plans

TELL US YOUR PREFERENCES

Share Your Preferences with AARP. Get the information you want. Take AARP's short preference survey to select which topics interest you. Click Here

MEDICARE ENROLLMENT AND PLAN SWITCHING

What do you need to do to enroll in Medicare? If you are already receiving Social Security benefits, you don't need to do anything - except have your 65th birthday. You are automatically enrolled in Medicare Part A and Part B effective the month you turn 65. (If your 65th birthday is June 15, 2012, your Medicare effective date is June 1, 2012. If your birthday is on the 1st day of any month, Medicare Part A and Part B will be effective the 1st day of the prior month.) Your Medicare card is mailed to you about three months before your 65th birthday.

Because you will pay a premium for Medicare Part B, you are allowed to opt out. You will be contacted by mail a few months prior to becoming eligible with instructions for how to do this. Also, if you live in Puerto Rico, or in a foreign country, you will not automatically be enrolled in Part B, so contact your Social Security office for more information.

If you are close to age 65 and not yet getting Social Security benefits or Medicare, you can apply for both at the same time. To make sure that your Medicare Part B coverage start date is not delayed, you should apply three months before the month you turn 65. This is the beginning of your 7-month Initial Enrollment Period. If you wait until you are 65, or in the last 3 months of your Initial Enrollment Period, your Medicare Part B coverage start date will be delayed.

REVIEW YOUR COVERAGE

It's important to evaluate your Medicare coverage at regular intervals - especially if your needs change and you require more care or lower out-of-pocket costs.

Additionally, from November 15 through December 31, you can enroll in, drop, or change your Part D prescription drug coverage. This is the only time of the year when you can do this, unless you qualify for an exception. This time is known as the Annual Election Period. In this period, you can also change or enroll in a Medicare Advantage plan.

From January 1 through March 31, you may change Medicare Advantage plans if you wish. Only one change per year is allowed. During this period, you may also return to Original Medicare. You cannot add or drop drug coverage during this period. If you have a Medicare Advantage plan with built-in drug coverage, you can only change to another plan if you maintain drug coverage.

LEARN ABOUT MEDICARE PLANS THAT CARRY THE AARP NAME WITH THE LINKS ON THIS PAGE

Enrollment Windows and Timing Chart
AARP Medicare Plan Finder
AARP MedicareComplete - Find a Doctor
AARP MedicareRx - Look Up Prescription Drugs

TELL US YOUR PREFERENCES

Share Your Preferences with AARP. Get the information you want. Take AARP's short preference survey to select which topics interest you. Click Here

PLANNING FOR YOUR HEALTHCARE COSTS UNDER MEDICARE

Understanding how Medicare coverage shares the costs of your care with you is important to choosing the right benefits. Your potential premium, deductible, co-payment and coinsurance combine to determine what costs Medicare will cover and what costs you will cover. (For more information on any of these terms, please visit the Heath Insurance Terms Glossary link on this page.)

The different parts of Medicare (Parts A-D) determine the amounts for premiums, deductibles, co-payments and coinsurance in different ways. And while it's easy to focus on costs of premiums, you should also look at how much that premium amount impacts what you'll spend on other out-of-pocket expenses, including deductibles, co-payments and coinsurance. There are times when a plan with a lower premium costs you more because it has a higher deductible, co-payment or coinsurance for the services you use.

There are a lot of good resources that can help you determine exactly how much you'll need to pay for the Medicare services you need.

LEARN MORE ABOUT MEDICARE WITH THE LINKS ON THIS PAGE.

Low Income Subsidy
Your Share of Part A Costs
Your Share of Part B Costs
Your Share of Part C Costs
Your Share of Part D Costs

TELL US YOUR PREFERENCES

Share Your Preferences with AARP. Get the information you want. Take AARP's short preference survey to select which topics interest you. Click Here

ADDITIONAL INFORMATION

There are many important life and health issues that Medicare doesn't cover. Depending on your individual coverage situation, you may need good options for long term care, dental, vision and hearing coverage. This site provides several high-quality resources to help you best understand your coverage situation. Get started with the articles on this page.

The Importance of Dental Insurance
Cost of Care Map
Valuable Discounts from AARP
Long Term Care Insurance
AARP Medicare Plan Finder for Plans that Carry the AARP Name

TELL US YOUR PREFERENCES

Share Your Preferences with AARP. Get the information you want. Take AARP's short preference survey to select which topics interest you. Click Here